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I don’t think George Will meant to be cruel when he wrote his recent article “The Time Bomb in Obamacare?” but he was and it is a recurring conservative mistake. Will focused on the law and the constitution. He found a bomb and he imagines he is a good bomb squad officer by analyzing the bomb and figuring out how it is going to blow up. What he missed, and it is crucial, is the vital step of clearing away the civilians. That is a cruel oversight and hurts the conservative cause. You have to make sure that people understand that there is a bomb and which direction to run so they do not get blown up.

The immediate threat for ordinary people is not Obamacare’s constitutional status, but what it will do to ordinary american’s access to care. Institutions that are caught in the payment squeeze will triage because otherwise they go broke and close, which would maximize suffering. Triage means that the lack of funds will cause them to try to maximize who they can save and cut off who they can’t afford to save. If you are going to be triaged, you need to know and you need to make alternate arrangements to pay cash, figure out how to live without needed care, or get your affairs in order. The later people figure this out, the more pain, suffering, and death Obamacare is going to cause.

Nothing George Will said about the law is wrong. By focusing on the Constitution and the law to the exclusion of the upcoming suffering of the people he ended up reinforcing a pernicious stereotype, one conservatives would do well to lose. Ultimately, the conservative focus on the law and the Constitution has the effect of reducing suffering and increasing the happiness of the people. This approach would be greatly increased in effectiveness if conservatives would directly say so instead of assuming people already knew. A great many people do not know and the conservative brand is suffering for it.

33 Responses to “Case Study in Conservative Cruelty: George Will”

The only refuge from the collapse of Obamacare will be the private market-based medical care industry. Eventually, the left will try to shut down the private option but, for a while, it will be the option. Canada learned after 30 years but we don’t have the private system just across the border that they do. The other option will be the county hospital systems but they are already overloaded with illegal immigrants.

Will is a pessimist, as I am, but he probably doesn’t know enough about how the present system works to see the future.

The ACA’s authors probably understood this perverse incentive and assumed that once Congress passed the ACA with penalties low enough to be politically palatable, Congress could increase them.

But Roberts’s decision limits Congress’s latitude by holding that the small size of the penalty is part of the reason it is, for constitutional purposes, a tax. It is not a “financial punishment” because it is not so steep that it effectively prohibits the choice of paying it. And, Roberts noted, “by statute, it can never be more.”

Surely, you know that statutes will not deter Obama from “fixing” his singular achievement. The rationing of care to the older population will be ignored. Ezekiel Emanuel has explained the reasoning.

As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”

Already the American College of Physicians has endorsed “parsimonious care.” That means the red pill instead of the pacemaker.

I know older people, in their 70s and 80s, some relatives of mine, Obama voters, mostly women. They all have significant health problems. They don’t see what is coming. I try to warn them gently, tell them that in the future they are probably going to have to start paying cash for some of the medical services they now receive via Medicare, that the medical system will probably restrict treatment options for cost reasons and won’t tell them about it, but they don’t get it. If I am blunt with them it either goes over their heads or they dismiss my concerns as paranoid and alarmist. The lefty elected officials, journalists and public intellectuals they pay attention to either lie to them or are themselves so clueless as to believe that the ACA won’t eventually lead to significant cutbacks in service. Some of these older people are going to die years earlier than they should, and there is little in the media or public discussion to educate them on what is going on. Will’s column is good, though I agree he could have been more direct about how the ACA will hurt people. But much more public discussion on this topic is needed. Maybe we’ll see such discussion as more people come to understand what they’re in for. I hope so.

“Canada learned after 30 years but we don’t have the private system just across the border that they do.”

You have pushed this lie several times now. In Canada all health care mandated as health care is part of the national scheme, run by the provinces. Only things that are outside of this, botox etc are allowed to be sold by private health care companies.

TM the point of universal health care is to reduce both suffering and costs. There will be a large effort to confuse the American public as there is a lot of money taken out of your system for … “costs”, that benefit providers take. They are fighting and will fight any change here.

More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations., compared with the months it takes for a public surgical suite to become available for nonessential operations.

“What we have in Canada is access to a government, state-mandated wait list,” said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. “You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list.”

Yet the move into privatized care threatens to make the delays — already long from the perennial shortage of doctors and rationing of facilities — even longer, public healthcare advocates say. There will be fewer skilled healthcare workers in government hospitals as doctors and nurses are lured into better-paying private jobs, they say.

“What it means is that people who have no money, who are chronically ill, disabled, who require medical attention frequently, are going to suffer dramatically,” said Leslie Dickout of the B.C. Health Coalition, which is involved in the lawsuit to determine whether the Canadian Constitution guarantees citizens the right to choose their own care.

While skirmishers in the ongoing battle between private and public health care in Canada continue to slug it out through court cases, regulatory complaints and debates, the swelling number of private clinics indicates that what once was privatization trickle may soon become a wave.

“What’s been tough is that it’s being done underhandedly,” says Cory Verbauwhede, a lawyer for Médecins Québécois pour le Régime Public, a pro-medicare group in Quebec. “No one is saying we’re privatizing the system, it’s being done bit by bit.”

No medical association or government body keeps official track of private clinics at a national level but what evidence exists suggests that the numbers have swollen well into the hundreds. In Quebec alone, there’s been a big explosion of private clinics, says Dr. Zoltan Nagy, president of the Canadian Independent Medical Clinics Association, a lobby organization for private health care in Canada.

Before you throw around terms like “lie” maybe you should check your facts. I’m tired of responding to dopes like you. There is this thing called Google. Jeeez !

Cruelty? This is assertion is absurd. Will here is analyzing an issue; in fact he mostly merely repeating the findings of other and commenting on these findings. He is under no moral obligation to offer either solutions of speculative warnings. Beyond that, how can an brief article be considered an act of cruelty.

To imagine that this is a Conservative “optics’ issue is surely quite bizarre, and places on obligation on Will he does not deserve and cannot possibly meet.

The cruelty here is, of course, on the hands of the progressives that have pushed this monster through.

Any health care in Canada that is mandated as health care goes through the national system. There are more and more non essential procedures that are allowed to be sold privately it’s true. It is possible to game the system to some extent, fold useful tests into a non essential procedure, but in general it’s quite difficult.

We wait a little longer than you do for routine stuff but we have such complete access to medical care as a normal, non rich person, that we put up with the delay. Harper knows that if he fools with our health care in any real way … he’s gone.

PenGun, you don’t know what you are talking about. Typical of trolls is assertion relying on no links or evidence. Show us your evidence. You don’t because you are wrong. I am not responding to you any more on this topic.

It is not enough to know the truth. You need to be able to prove that what you say is ‘true’ is indeed true. That is how science works.

The next problem has to do with evidence. Hard sciences, such as Physics are based on Experiments. The results of experiments provide evidence.

Evidence: Every time I drop a red ball, it falls down. If you drop a red ball, it falls down. If a dog drops a red ball, it falls down.

This is an experiment that any person or any animal or any machine can try and always get the same result. When a red ball is dropped, it falls down. One may interpret this evidence as proving that a red ball will always fall down.

Some people have proposed the theory that any ball, no matter the color, will fall down.

In this blog we search for truth. You can help by giving evidence that helps separate fact for fancy.

Law schools have courses which teach Rules of Evidence. Science schools have courses dedicated to rules for gathering and evaluating evidence.

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The first of its type to be built in Canada, the centre has a total of 16,500 square feet of clinical space on 3 levels. Cambie Surgery Centre is one of the largest and most technologically advanced private surgical facilities in Canada. The centre has 6 state of the art operating rooms, eleven recovery beds and seven overnight stay rooms. Patients requiring overnight care are admitted to private rooms and are cared for by specially trained registered nurses.

Surgeons at the Cambie Surgery Centre are nationally and internationally renowned and specialize in minimally invasive surgical techniques not always available at other facilities. Procedures performed with less invasive techniques allow for a quicker recovery.

However – they have been voting this country further into ruin for decades, they helped forge what are now bonds for us all.

You cannot have gray hair and claim innocence. They are innocent as Madoff’s investors – they thought they were picking the other fellows pocket. It is you who took, and now you’re being taken.

As for the Boomers: you have eaten it all, left none for the rest, and you made near gods of Progs who’s firm policy is to salt the earth for those after them. Why should we pity you that you come up short?

Whitehall – The technique is not necessarily reactive. I’ve used it proactively in the past with some success. Big government *is* cruel and not just in a 1984 way.
Hattip – Yes, Will is analyzing an issue. He sees law and rules but not the people who will be hurt. He is the bomb disposal guy who lets civilians crowd around while he analyzes the bomb to be disarmed. If that is not cruel, what do you call it? Is irresponsible or stupid more acceptable terminology?

Jonathen – Stop being gentle, the time for that is past. They need to start preparing now to weather the coming storm.

PenGun – Universal care is fine if you can afford it. The more broken the resource allocation mechanism for universal care, the richer you have to be to afford it. The US is nowhere near rich enough to afford the broken pricing system of Obamacare. The consequence will be triage and a certain excess of suffering, misery, and death over what would happen if we fixed medical care pricing.

VSSC – Some of those gray hairs are on people who hate socialism and simply got overwhelmed and lost the political fight. Those people do deserve sympathy.

There is a way to fix health care and I have studied it and written about it here. That was about 2008 before Obama and , ironically, I was attacked by the lefties at Washington Monthly because they thought I supported single payer and found out otherwise. The French have the best health care system in Europe, or did when I wrote that. The quality is excellent and the cost is less than ours. Much of the basis of the system is exactly opposite the incentives of Obamacare.

France is also the only large country with a system that could be compared to ours. Germany is quite different in culture and the health care system is one they have had since Bismarck. The other countries are smaller except England, which has the NHS and that is a disaster. In 2008, surveys in England reported that 60+% believed the NHS was so bad they would have to start over. It could not be reformed.

I don’t think we can fix Obamacare and the opportunities for graft and corruption pretty well rule out realistic attempts to try. Our corrupt political class are driving us to ruin.

Some people don’t listen and can’t be reasoned with. From their POV they are older and more experienced in life, and I am an excitable fellow with silly politics who is always saying crazy things about Obama. And now I’m telling them that the institutions they have trusted forever are going to fall apart. It’s a tough sell, and I can’t force them to do anything.

Boy! I’d say you proved my point but I’m not sure you would understand. I will try though.

Do you have any idea what the difference between a mandated procedure to treat a normal affliction, as is found in all mandated health services, and a voluntary procedure, often for cosmetic reasons, is? It appears not.

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The firm operations of our governing class are to eat it all, leave none for the rest and salt the earth for those who come after.
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That’s our government and our governing class Pengun, SO, et al..

So no they can’t be trusted with HealthCare. In fact they can’t be trusted with AmTrak’s snack foods. It seems they always lose money on AmTrak snacks, and an exquisitely torturous analysis revealed that every level of the supply chain is STEALING. It also concludes with the usual USG policy in these matters; that’s it’s NO ONE’s job to stop the thefts. That worthies is USG in one nicely packaged, eternally preserved in chemical amber sweet confection;

**Everyone is stealing, it’s no ones responsiblity to stop it**.

USG in one tasty, poisonious, cleverly packaged gulp.

Which BTW was the conclusion of the reviews on the Bremer/CPA/Iraq fiasco. No one was responsible.

About 10 years ago my son was engaged to a Canadian woman. They met in Korea while both were teaching English there. They returned to their respective homes, he to Baltimore and she to a small town in rural Ontario, to wait for permission for her to permanently come to the US so they could marry. She discovered a mole on her thigh and visited her doctor. He told her that he didn’t like the look of the mole and that she needed to see a specialist in Toronto. It turned out that she couldn’t be seen by a specialist (I assume a dermatologist) for several months. She called my son, and he told her to get in her car and drive to Baltimore. In 3 days she was seen at Johns Hopkins, diagnosed with a malignant melanoma and had it removed. She was told that had she waited several months, the cancer would most likely have metastasized and could very well have killed her. I wouldn’t call this a “voluntary procedure”.

I have a friend who is a pilot for a med-evac company, flying fixed wing aircraft. He’s based in Wyoming. He tells me that it is not unusual for him to fly Canadians to US hospitals for many different procedures, especially difficult births, as there are not the needed facilities and/or personnel for hundreds of miles in places in central Canada, and no provisions to move emergency cases quickly.

I am a “boomer” and I’ve been opposed to the liberal financial giveaways my whole adult life. I’ve never voted for a democrat and have always been a financial conservative. There are millions of other “boomers” just like me. Please don’t lump everyone in an age group into one ideological niche. Although easy to do, it’s tiresome and simply incorrect. Sometimes you fight the good fight and still lose.

Further to one of Mike Doughty’s points, the radicals, counterculture-enthusiasts, hippies, etc. were always a minority of the boomers, even back in the 60s. Read about the campus uprisings in the late 60s and early 70s – most students, even at Columbia, did NOT support the radicals. And in the election last November, Romney carried white boomers handily. The problem is that the radical minority of that generation went on to take over the opinion shaping industries and institutions of the country. As a result, young Americans today are far more leftwing, as a group, than the young Americans of a generation or two ago.

It is a waste of time to try to educate ex-garbage truck driver PenGun. He is determined that everything Canadian is better so I won’t try.

“Do you have any idea what the difference between a mandated procedure to treat a normal affliction, as is found in all mandated health services, and a voluntary procedure, often for cosmetic reasons, is? It appears not.”

What is listed in those web sites for private clinics are elective procedures and treatment, like primary care. Canada stopped building hospitals in the 1980s. I attended a quality improvement seminar with the architect who was designing the first new Canadian hospital in 30 years. Medical school enrollment was capped and some nursing schools were closed. It was government policy to import doctors and nurses from third world countries.

If you knew anything, you might be surprised at how many major operations can now be done with 24 hour stays in surgery centers. I started doing laparoscopic gall bladder surgery as an outpatient procedure in 1988. Now, there are many more procedures that are done that way.

What is left are emergencies but the Canadian system is still slow to deal with such cases, as Natasha Richardson found out when she bumped her head skiing.

Jonathan – In cases such as you describe, I generally shift the topic to estate planning and recording their lives and experiences for posterity. As you say, some people can’t be reasoned with. That doesn’t mean that damage mitigation is not possible. In marginal cases, providing a highlighted and annotated copy of the trustees report on Medicare and Social Security will help. Most such people are unaware that Medicare is currently scheduled to have an ~ 35% payout cut at the end of the year and all analysis of the program’s viability has to take those cuts (which have a snowball’s chance in hell of actually happening) as given in any analysis of the sustainability of these programs.

PenGun – Do you have any idea how weaselly bureaucrats can get in every country? The species tends not to vary much. With the stroke of a pen they can turn that mandatory treatment into a voluntary one. Did they? That’s a question that neither of you have really answered but I know which way I’m betting…

VSSC – You can enter into a private medical arrangement with a concierge practice, at least so long as there are slots left. That opportunity has not ended yet. Ignorance is only bliss until your physicians go concierge and those left in the regular system are not taking new patients.

The physician siblings I have all report that there are many practitioners who are seriously considering closing their practice and retiring after 1/1/2014.
In addition, many are not taking new Medicare patients, and are notifying their current Medicare patients that they are not accepting the Medicare payment as full, and are requesting patients to pay in cash, and submit reimbursement requests to the Medicare system.
I might be off on the exact details, but being forced into Medicare a few months from now has spurred my attention and made me very wary of the future for seniors.
In my opinion, George Will is not a part of the Republican power structure, and as such has no influence on their strategy or tactics to counter the Liberals. If you read closely, you should note that he is reporting on the observations of a professor at a law school.
I find it a small bit of hope in a generally dismal future, not a negative, but a possibility that ACA will find itself cast upon the rocks and shoals of reality – arithmetic, as our President noted recently. Of which, he is vaguely familiar given his oft repeated concerns about fairness and taxing the ‘rich’. {joke.} He blithely insists the rich have enough resource to balance the budget and pay for all his largess which overwhelms our tax dollars, when in truth, his ‘rich’ would provide a proverbial drop in the bucket. Mathematics, my left butt cheek.
tom

Tomw – The charge of cruelty is about ignoring the human cost when the “ACA will find itself cast upon the rocks and shoals of reality”. There will be a body count associated with that. People should be horrified if they spent a lot of time reforming medicine and in the end, the old system died for one that kills more people. By keeping things bloodless, we let the left off the hook and don’t wedge their coalition. Why should we play nice to the lefty pols? Who benefits by keeping the oldsters in the dark?

A case in point. I went for an eye examination, the first in a long time on Tuesday the 22nd. She identified a tear in my retina. On Thursday the 24th, in Victoria some 100 miles from my backwoods home, I had laser surgery to fix that.